Relationship Between Categorization With the STarT Back Screening Tool and Prognosis for People Receiving Physical Therapy for Low Back Pain

Fritz, Julie M.; Beneciuk, Jason M.; George, Steven Z.

doi:10.2522/ptj.20100109

Cited by 112 publications

(91 citation statements)

References 29 publications

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Section: Discussionmentioning

confidence: 99%

“…Two other primary care studies used different methodological approaches to asses the predictive ability of SBT [2,8]. In one study, SBT sum scores were used as a continuous scale in longitudinal modelling of a non-uniform outcome period [8]. In the other study the SBT sum scores and the outcome measures were used as continuous scales in multiple linear regression modelling to monitor of change during treatment and avoid the borderline misclassification of cases [2].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, a high-quality randomised controlled trial that matched treatment pathways to each SBT subgroup showed improved patient outcomes and cost-effectiveness [9]. Overall, this evidence suggests that the SBT can provide important prognostic information in primary care settings [8], changes in SBT overall scores may provide important clinical decisionmaking information for treatment monitoring [2], SBTtargeted treatment can be effective [10], and the SBT is well accepted by primary care clinicians. In addition, research is being undertaken into appropriate implementation strategies for the SBT in primary care [11].…”

Section: Introductionmentioning

confidence: 93%

“…On the basis of potentially modifiable prognostic factors, the SBT classifies people into prognostic subgroups and identifies targeted treatment pathways for those subgroups [1]. The construct, concurrent and predictive validity of the SBT has been investigated [2][3][4]; it has been translated into several languages [5][6][7] and its cross-cultural validity and cross-cultural predictive ability have been described [7,8]. In addition, a high-quality randomised controlled trial that matched treatment pathways to each SBT subgroup showed improved patient outcomes and cost-effectiveness [9].…”

Section: Introductionmentioning

confidence: 99%

“…A number of studies have tested the predictive ability in primary care [1,2,8,15], but no previous studies have investigated and reported the predictive ability of SBT in secondary care. Therefore, the aim of the current study was to extend previous investigations of the SBT by comparing the predictive ability of the SBT in a Danish secondary care setting and a Danish primary care setting.…”

Section: Introductionmentioning

confidence: 99%

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The predictive ability of the STarT Back Screening Tool in a Danish secondary care setting

et al. 2013

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Introduction The predictive ability of the STarT Back Tool (SBT) in secondary care settings has not been investigated. The aim of this study was to determine the SBT's predictive ability in a Danish secondary care setting and compare this to a Danish primary care setting. Methods Poor clinical outcome at 6 months ([30 points on a 0-100 Roland Morris Disability Scale) was calculated in secondary care (n = 960) and primary care (n = 172) cohorts. The cohorts were stratified into SBT subgroups and estimates of additional risk for poor outcome were calculated [relative risk (RR), unadjusted and adjusted odds ratios]. The discriminative ability was determined using the area under the curve statistic. Results In secondary care 69.0 % and in primary care 40.2 % had poor outcome on activity limitation. Although significant, the predictive ability of the SBT in secondary care (medium-risk RR 1.5, high-risk RR 1.7) was not as strong as in primary care (medium-risk RR 2.3, high-risk RR 3.5). Adjusting for episode duration and pain intensity only changed the predictive ability marginally in secondary care. The discriminative ability of the SBT was similar in both cohorts despite differences in the predictive ability. Conclusion The SBT had less predictive ability in a Danish secondary care setting compared to a Danish primary care setting for persistent activity limitation at 6 months follow-up. SBT-targeted treatment implications in secondary care were not investigated in this study.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The predictive ability of the STarT Back Screening Tool in a Danish secondary care setting

et al. 2013

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STarT Back Tool risk stratification is associated with changes in movement profile and sensory discrimination in low back pain: A study of 290 patients

Rabey

Kendell

Godden

et al. 2019

European Journal of Pain

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Background Investigation of movement and sensory profiles across STarT Back risk subgroups. Methods A chronic low back pain cohort (n = 290) were classified as low, medium or high risk using the STarT Back Tool, and completed a repeated spinal bending task and quantitative sensory testing. Pain summation, time taken and the number of protective behaviours with repeated bending were measured. Sensory tests included two‐point discrimination, temporal summation, pressure/thermal pain thresholds and conditioned pain modulation. Subgroups were profiled against movement and sensory variables. Results The high‐risk subgroup demonstrated greater pain summation following repeated forward bending (p < 0.001). The medium‐risk subgroup demonstrated greater pain summation following repeated backward bending (p = 0.032). Medium‐ and high‐risk subgroups demonstrated greater forward/backward bend time compared to the low‐risk subgroup (p = 0.001, p = 0.005, respectively). Medium‐ and high‐risk subgroups demonstrated a higher number of protective behaviours per forward bend compared to the low‐risk subgroup (p = 0.008). For sensory variables, only two‐point discrimination differed between subgroups, with medium‐ and high‐risk subgroups demonstrating higher thresholds (p = 0.016). Conclusions This study showed altered movement characteristics and sensory discrimination across SBT risk subgroups in people with CLBP. Membership of the high SBT risk subgroup was associated with greater pain and disability levels, greater pain summation following repeated bending, slower bending times, a greater number of protective behaviours during forward bending, and a higher TPD threshold. Treatment outcomes for higher risk SBT subgroups may be enhanced by interventions specifically targeting movement and sensory alterations. Significance In 290 people with chronic low back pain movement profile and two‐point discrimination threshold differed across risk subgroups defined by the STarT Back Tool. Conversely, pain sensitivity did not differ across these subgroups. These findings may add further guidance for targeted care in these subgroups.

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Predictive validity of the STarT Back screening tool among older adults with back pain

Vigdal,

Flugstad,

Storheim

et al. 2024

European Journal of Pain

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BackgroundThe predictive validity of the STarT Back screening tool among older adults is uncertain. This study aimed to assess the predictive validity of the SBT among older adults in primary care.MethodsThis prospective cohort study included 452 patients aged ≥55 years seeking Norwegian primary care with a new episode of back pain. A poor outcome (persistent disabling back pain) was defined as a score of ≥7/24 on the Roland‐Morris Disability Questionnaire (RMDQ) at 3, 6 or 12 months of follow‐up. The ability of the SBT risk groups to identify persistent disabling back pain was assessed with multivariable logistic regression, area under receiver operating characteristics curve (AUC), and with the accuracy measures sensitivity, specificity, predictive values and likelihood ratios.ResultsThe adjusted odds ratios (95% CI) for persistent disabling back pain were 2.40 (1.34–4.30) at 3 months, 3.42 (1.76–6.67) at 6 months and 2.81 (1.47–5.38) at 12 months for the medium‐risk group (n = 118), and 8.90 (1.83–43.24), 2.66 (0.81–8.67) and 4.53 (1.24–16.46) for the high‐risk group (n = 27), compared to the low‐risk group (n = 282). There were no statistically significant differences in odds between the medium‐ and high‐risk groups at any time point. AUC values (95% CI) were 0.65 (0.59–0.71), 0.67 (0.60–0.73) and 0.65 (0.58–0.71) at 3, 6 and 12 months. Accuracy measures were poor at all time points, with particularly poor sensitivity and negative likelihood ratio values.ConclusionThe predictive validity of the SBT risk groups in predicting persistent disabling back pain in older adults was poor.Significance StatementThis study found that the STarT Back screening tool had poor predictive validity among older adults and that it may need recalibration or extension before widespread implementation among older adults. Having valid tools for this population may aid clinicians with allocating scarce healthcare resources, which is especially important considering the rapidly ageing population and its expected challenge to the healthcare systems.

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Relationship Between Categorization With the STarT Back Screening Tool and Prognosis for People Receiving Physical Therapy for Low Back Pain

Abstract: The SBT may provide important prognostic information for physical therapists.

Cited by 112 publications

References 29 publications

The predictive ability of the STarT Back Screening Tool in a Danish secondary care setting

The predictive ability of the STarT Back Screening Tool in a Danish secondary care setting

STarT Back Tool risk stratification is associated with changes in movement profile and sensory discrimination in low back pain: A study of 290 patients

Predictive validity of the STarT Back screening tool among older adults with back pain

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